Gastroenterology & Hepatology

February 2022 - Volume 18, Issue 2

Letter From the Editor: Diagnosing and Managing Abdominal Bloating and Distension

Gary R. Lichtenstein, MD, AGAF, FACP, FACG

It is well recognized that abdominal bloating and distension are common gastrointestinal symptoms. As Dr David J. Cangemi and Dr Brian E. Lacy note in a review article in this month’s issue of Gastroenterology & Hepatology, almost every person has had these symptoms at least occasionally. Although abdominal bloating and distension are often not frequent or long-lasting, they can be chronic and can adversely impact the quality of life of some people. Unfortunately, these symptoms can be challenging to diagnose and treat, as they are nonspecific, and there are no uniform diagnostic or treatment algorithms. In their article, Dr Cangemi and Dr Lacy provide a practical approach for assessing and managing patients who present with these symptoms through examination of key etiologies (diet, small intestinal bacterial overgrowth, constipation, visceral hypersensitivity, and abdomino-phrenic dyssynergia).

Another review article this month focuses on the treatment of hepatitis C virus (HCV) infection before and after solid organ transplantation. Dr Ronit Patnaik and Dr Eugenia Tsai start by reviewing the significant recent advances of direct-acting antiviral (DAA) therapy for HCV infection. The authors then examine the data currently available on DAA treatment in patients undergoing liver transplant and simultaneous liver-kidney transplant. The authors also look at the transplantation of HCV-positive organs (particularly livers, kidneys, and hearts) into HCV-negative patients. 

Our third review article this month highlights the use of nutrition in the management of patients who have inflammatory bowel disease (IBD). Dr Jaya Vasudevan, Ms Clara DiVincenzo, and Dr Linda A. Feagins review the progress of dietary therapy in this patient population, screening and assessment tools for malnutrition, and drug-nutrient interactions. The authors also examine a number of diets currently being studied in IBD, including exclusive enteral nutrition, the Specific Carbohydrate Diet, and the Mediterranean diet, and note the data currently available or underway on each diet as well as the need for further research. 

Our IBD coverage continues with our Advances in IBD column on IBD medications and sperm quality. Along with related issues, Dr Anne Grosen discusses how male fertility can be assessed and provides a comprehensive review of the research conducted thus far on whether thiopurines, anti–tumor necrosis factor inhibitors, vedo­lizumab, ustekinumab, tofacitinib, and methotrexate can affect sperm. 

Our Advances in Endoscopy column focuses on endoscopic management of gastric intestinal metaplasia. Among other issues, Dr James Buxbaum discusses the role of endoscopy in the surveillance of gastric intestinal metaplasia, whether narrow-band imaging should be considered the gold standard, the use of other image enhancement technologies, protocols for random and targeted biopsies, and endoscopic advances that are expected in the near future.

Extraesophageal gastroesophageal reflux disease (GERD) is highlighted in our Advances in GERD column. Dr Anjana Sathyamurthy discusses the prevalence of extraesophageal symptoms in GERD patients, the challenges of diagnosing extraesophageal GERD in a timely manner, diagnostic testing for this condition, the role of mucosal impedance, and various treatment options, along with related issues. 

Finally, our Advances in Hepatology column reviews transient elastography in children. Sadly, the author, Dr Tamir Miloh, passed away at the age of 53 after being interviewed for this column. His death is a great loss for the pediatric hepatology community, where he touched many lives. All of us at Gastroenterology & Hepatology send condolences to his family and friends.

I hope these articles are useful for your practice.


Gary R. Lichtenstein, MD, AGAF, FACP, FACG

Millennium Medical Publishing, Inc